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On Being a Doctor |

Identity Theft

Margaret Seton, MD
[+] Article and Author Information

From Harvard Medical School, Boston, MA 02114.


Requests for Single Reprints: Margaret Seton, MD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; e-mail, margaret_seton@hms.harvard.edu.


Ann Intern Med. 2010;152(12):820. doi:10.7326/0003-4819-152-12-201006150-00013
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I remember a night on call in the hospital during my first year as a categorical intern in internal medicine in 1984. At 3:00 a.m., I was called to the floor because Mr. J.'s intravenous line had fallen out. He developed blood in his urine after prostate surgery and urgently needed intravenous procoagulant therapy. I checked my sign-off of patients: Mr. J. was an elderly man with a myelodysplastic syndrome who had required immediate prostate surgery. I knew his name. He had been on the medical service for a while; his prognosis was guarded, as he had platelet dysfunction before surgery.

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No Title
Posted on July 15, 2010
martin m. grajower
aecom
Conflict of Interest: None Declared
The "anonymity of patients" described by Dr. Seton ("Identity Theft") is actually excellent training for the world of medicine that is evolving. A patient recently returned to me "out of network" after several years seeing a doctor in network. She complained of something that had been present for 6 months. When I asked her what the previous doctor had said, she told me he never looked at her or allowed her to ask questions. Her monthly visit consisted only of the doctor writing out whichever prescriptions she needed refilled. How else to see so many patients an hour? With electronic medical records the situation gets even worse. Separating the doctor from the patient is a computer screen on which the doctor diligently checks off all those boxes that will qualify the visit for a higher E&M code. I agree with Dr. Seton, having done my internship in 1973-74. Unfortunately, making eye contact, reading the expression of the patient, and sensing what they are really feeling and saying, are not on the checklist of the EMR. In other words, those are aspects of the visit that are not subject to documentation. And if you don't document it, it didn't happen. And if it didn't happen, why do it? I agree with Dr. Seton. I am just pessimistic that the climate within which we are all being forced to practice cares little about the things she talks about. The time she spent discussing the spelling of the patient's name and correcting it on his chart and door label are not reimbursable time. EMR will only serve to further dehumanize the practice of medicine in the name of efficiency and portability. The good news: the patient won't see the computer screen to know if his name is spelled correctly.

Conflict of Interest:

None declared

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